May 13, 2016
In the U.S. today, more than 600,000 children participate in gymnastics. But, as the competition gets tougher, more gymnasts are getting injured. Last year, there were 86,000 gymnastics-related injuries treated in hospitals, doctors' offices, clinics and ambulatory surgery centers. Some of these were acute injuries (the result of unfortunate accidents), but some were also from overuse.
One overuse condition increasingly seen in gymnasts is osteochondritis dissecans (OCD) which develops in joints and worsens with repetitive use.
What is Osteochondritis Dissecans?
OCD is a joint disorder that occurs when a small portion of a bone within a joint, commonly the elbow, begins to separate from its surrounding region. Part of this is due to a lack of blood supply. Consequently, the small bone fragment and the cartilage covering it start to crack and loosen. When this happens, a patient experiences pain and swelling. Sometimes, the joint may even lock, which limits an individual's range of motion.
OCD is thought to be caused by repetitive stress to the bone over time, as well as a possible genetic predisposition to the condition. Gymnastics can certainly contribute to the development of OCD due to the high joint stresses involved. The condition is seen most commonly in children and adolescents, with the knee and elbow being most affected.
One Gymnast's Story
This was the case for competitive gymnast, Libby Roach of Chicago. Her mother, Lisa Roach, explains that by third grade, Libby could no longer straighten her right arm and she had a "dull ache" in her elbow. By the fifth grade, Libby was a level 7 gymnast who also realized she had osteochondritis dissecans.
After two years and consulting with five doctors who were not positive of Libby's diagnosis, even though her pain had significantly increased, Ms. Roach was referred to Dr. Mark Cohen, co-director of the Midwest Orthopaedics at Rush (MOR) Minimally Invasive Hand, Wrist & Elbow Institute.
After an examination and reviewing her X-rays, Dr. Cohen concluded that Libby had OCD of her elbow. The images showed a spot consistent with an area of the elbow that lost its blood supply and was fragmented. Dr. Cohen confirmed that this was the one of the worst cases of OCD he had seen.
"While the incidence of osteochondritis dissecans is increasing, the age at which we see it is also getting younger," explains Dr. Cohen. "It commonly affects adolescents because they haven't reached skeletal maturity so their cartilage is weaker and more susceptible to blood supply loss and injury."
Libby underwent surgery, which involved removing the lesion in the elbow, with methods to stimulate the underlying bone to create pathways for new blood vessels to heal the affected area. Two years later in 2012, Libby was forced to undergo surgery for her opposite elbow, which also was affected by OCD.
Her mother calls the surgeries a great success.
"My family was so happy to find a physician like Dr. Cohen who understood what needed to be done for Libby," she explains. "Many people, even doctors, are unaware of what OCD really is and are probably competing undiagnosed."
After the surgery, it was recommended that Libby no longer compete in gymnastics. "At first, Libby was devastated," explains Lisa. "However, she is now in the ninth grade, feeling virtually no pain and having fun as a cheerleader." Today, Libby has regained her full range of motion.
Dr. Cohen warns that OCD is increasing in young athletes, especially in gymnasts. "Many young athletes are performing and practicing at levels that put their bodies at risk for over-use injuries, like OCD." He recommends intervening early if your young gymnast or athlete complains of pain in their joints. He advises parents to be on the look-out for tenderness or sensitivity in a joint, locking of the elbow and/or a limited range of motion.
